ANESTHESIA TECHNIQUES | General Anesthesia, TIVA, MAC, and Sedation, Co-existing Disease Flashcards
The leading cause of death and severe nervous system injury during MAC is:
A. Hypoxia
B. Arrhythmia
C. Hypoxemia
D. Circulatory collapse
A. Hypoxia
Barash | 9th edit
TRUE or FALSE
At the present time, no single drug can provide all the
components of monitored anesthesia care (i.e., analgesia,
anxiolysis, and hypnosis) with an acceptable margin of safety or ease of titratability.
TRUE
TRUE or FALSE
Monitored anesthesia care DOES NOT describe the continuum of depth of sedation
TRUE
This depth of sedation maintains normal response to verbal stimuli and the airway, spontaneous ventilation, and cardiovascular function are unaffected.
A. Minimal
B. Moderate
C. Deep
D. General Anesthesia
A. Minimal
The depth of sedation often referred to as “conscious sedation”. It maintains purposeful response to verbal and light touch stimuli
A. Minimal
B. Moderate
C. Deep
D. General Anesthesia
B. Moderate
This depth of sedation maintains purposeful response to REPEATED or painful stimuli but may lose responsiveness to verbal or light touch stimuli:
A. Minimal
B. Moderate
C. Deep
D. General Anesthesia
C. Deep
- cardiovascular function is usually
maintained even if AIRWAY may need assistance.
Based on MODIFIED RAMSAY sedation scale, The following assessment corresponds to which of the following score?
The following are observed:
Patient appears asleep, purposeful responses to verbal commands but at louder than usual conversational level, requiring light glabellar tap, or both. What is the RAMSAY score?
A. 8
B. 6
C. 4
D. 3
C. 4
The patient has no response to voice, but any movement to physical stimulation is elicited corresponds to what RASS score:
A. -2
B. -3
C. -4
C. -4
-5 No response to voice or physical stimulation
-4 No response to voice, but any movement to physical stimulation
-3 Any movement (but no eye
contact) to voice
-2 awakens in less than 10 secs
with eye contact to voice
-1 Not fully alert, but has sustained
(more than 10 s) awakening, with
eye contact, to voice
0 Alert and Calm
+1 to +4 = * Scores indicate restlessness to combativeness and do not reflect anxiolysis
Based on the ASA closed claims study, what is the the leading cause of death and severe nervous system injury during MAC?
A. Hypoxia
B. Arryhthmia
C. Seizure
D. Hypoxemia
A. Hypoxia
From the ASA closed claims study of Bhananker et al.,5 we learned that the leading cause of death and severe nervous system injury during MAC is hypoxia due to suppression of spontaneous respiration by sedative– hypnotic drugs
CONTEXT SENSITIVE HALF-TIME of Fentanyl
In the case of fentanyl, drug that is irreversibly eliminated from the plasma by hepatic clearance is immediately replaced by drug returning from the peripheral compartments.
Thus, although fentanyl has a shorter elimination half-life than that of sufentanil (462 vs. 577 minutes), its context-sensitive half-time is much greater than that of sufentanil after an infusion of longer than 2 hours. The storage, and later release, of fentanyl from peripheral binding sites delay the decline in plasma concentration that
would otherwise occur.
What is the clinical reason between thiopental and propofol in terms of their context-sensitive H/T?
This difference between thiopental and propofol is attributable to:
(1) the high metabolic clearance of propofol compared with thiopental, and
(2) the relatively slow rate at which propofol returns to the plasma from peripheral
compartments.
A patient undergoing lumbar spine fusion surgery is monitored by measuring lower extremity somatosensory evoked potentials (SSEPs). Which of the following is MOST likely to cause a 50% INCREASE from baseline in the SSEP latency?
A. Anterior spinal artery ischemia
B. Compression of the anterior column of the spinal cord
C. Changing from an inhaled anesthetic to a total intravenous anesthetic
D. Compression of the dorsal column of the spinal cord
A. Anterior spinal artery ischemia
- Anterior spinal cord compression may not have any effect on SSEPs.
- Changing to a total intravenous anesthetic would most likely decrease SSEP latency.
- Lower extremity SSEPs are not transmitted by the dorsal column of the spinal cord.
Cyclosporine toxicity is MOST commonly seen in which of the following solid organs?
A. Lung
B. Kidney
C. Pancreas
D. Heart
B. Kidney
- Although cyclosporine has been reported to be associated with the development of bronchospasm, cough, and dyspnea, pulmonary sequelae are not the most common complications.
- Toxicity of the pancreas does not occur with cyclosporine administration.
*Although cyclosporine has been reported to be associated with myocardial infarction, dysrhythmias,
and heart failure, cardiac complications are not the most common manifestation of cyclosporine
toxicity.
In adults under general anesthesia, which one of the
following is the best-preserved temperature regulatory
mechanism?
A. Vasoconstriction
B. Shivering
C. Sweating
D. Behavioral thermoregulation
E. Nonshivering thermogenesis
C. Sweating
The thermoregulatory threshold, below which humans
actively regulate body temperature, is decreased during
general anesthesia and is less effective under anesthesia.
Compared to the other homeothermic mechanisms, sweating is the best-preserved mechanism under general anesthesia.
The threshold for sweating is only slightly increased
and the effectiveness of sweating is well preserved under
general anesthesia. Under general anesthesia the thresholds
for shivering and vasoconstriction are markedly reduced
and less effective than normal when activated.
- Nonshivering thermogenesis does not occur in anesthetized adults and is inhibited in infants.
Which mechanism for heat loss is most significant in
anesthetized surgical patients?
A. Convection
B. Radiation
C. Conduction
D. Evaporation
B. Radiation
Which of the following agent or drugs is HIGHLY considered to be safe from MALIGNANT HYPERTHERMIA?
A. Succinylcholine
B. Droperidol
C. Nitrous Oxide
D. Halothane
B. Droperidol
Which of the following is the MOST deleterious effect of neonatal hypothermia?
A) Acute hypoglycemia
B) Atrial fibrillation
C) Decreased plasma metanephrines
D) Metabolic acidosis
E) PEA
D) Metabolic acidosis
Metabolic acidosis, which results from ketone production in brown fat metabolism (nonshivering thermogenesis), is maladaptive in the neonate and is the most critical consequence of a decrease in temperature.
Neonates and infants are at a higher risk of hypothermia, especially in the operating room, as they lack the normal compensatory mechanism of shivering. Neonates have a larger body surface area-to-weight ratio and less subcutaneous fat, both of which help to promote heat loss.
In a response to heat loss, neonates begin a process called nonshivering thermogenesis. Nonshivering thermogenesis is the metabolism of brown fat. Brown fat makes up 4-10% of fat stores in the neonate and is high in mitochondria. Brown fat can be found in a neonate from 26 weeks and up and disappears around 3-6 months after birth.
When there is at least a 2° C (3.6° F) gradient between the skin and core temperature, the hypothalamus stimulates a release of norepinephrine into the blood stream.
Which of the following mechanisms is most frequently responsible for hypoxia in the recovery room?
A. Ventilation/perfusion mismatch
B. Hypoventilation
C. Hypoxic gas mixture
D. Intracardiac shunt
A. Ventilation/perfusion mismatch
Hypoparathyroidism secondary to the inadvertent surgical resection of the parathyroid glands during total thyroidectomy typically results in airway symptoms of hypocalcemia how many hours postoperatively?
A. 1 to 2 hours
B. 3 to 12 hours
C. 12 to 24 hours
D. 24 to 72 hours
D. 24 to 72 hours
Damage to which nerve may lead to wrist drop?
A. Radial
B. Axillary
C. Median
D. Ulnar
A. Radial
A 25-year-old woman with a body mass index (BMI) 42 kg/m2 is to be anesthetized for laparoscopic bariatric surgery. Her American Society of Anesthesiologists (ASA)
designation should be:
A. ASA I
B. ASA II
C. ASA III
D. ASA IV
C. ASA III
Which of the following oral antidiabetic drugs is unique in that it does NOT produce hypoglycemia when administered to a fasting patient?
A. Glyburide (Micronase)
B. Glipizide (Glucotrol)
C. Tolbutamide (Orinase)
D. Metformin (Glucophage)
D. Metformin (Glucophage)
Scopolamine should not be given as a premedication in patients with which of the following neurologic diseases?
A. Parkinson disease
B. Alzheimer disease
C. Multiple sclerosis
D. Narcolepsy
B. Alzheimer disease
Which of the following is LEAST likely to develop intraoperative awareness?
A. C- section under GA
B. Emergency damage control laparotomy
C. history of opioid use
D. patient with red hair
D. patient with red hair
MAC is primarily an indicator of ___
A. solubility
B. potency
C. uptake
D. partial pressure at 1 ATM
B. potency
Modified child-pugh score utilizes the following parameters EXCEPT:
A. Ascites
B. Encephalopathy
C. INR
D. ALT
ALT
